Central Line-associated Bloodstream Infections in a Neonatal Intensive Care Unit: A Quality Improvement Study

Abstract

Purpose

Neonates admitted to the neonatal intensive care unit (NICU) frequently need central line placement, which significantly increases their susceptibility to central line-associated bloodstream infections (CLABSIs). This study aimed to improve adherence to CLABSI care maintenance bundles in our NICU with the aim of reducing infection rates.

Methods

This quality improvement (QI) study was conducted in a tertiary-care NICU. The QI team included a consultant neonatologist, a senior resident, and three experienced staff nurses. A fishbone analysis showed potential barriers, leading to the development of two interventions: training on CLABSI maintenance care bundles, and the decision by doctors in morning rounds about changing the dressing of the central catheter. These interventions were evaluated using two plan-do-study-act (PDSA) cycles.

Results

Initial adherence to CLABSI maintenance care bundles was 65%, with a high CLABSI rate of 13.25 cases per 1,000 central line days in the baseline phase (June-October 2023). After the implementation of the first PDSA cycle (November 2023-January 2024), adherence surged to 97.4%, and CLABSI was reduced to 5.95 cases per 1,000 central line days. At the end of the second PDSA cycle, the CLABSI rate reached 0 per 1,000 central line days with 100% adherence. During the sustenance phase (April-June 2024), adherence was 99.4%, and the CLABSI rate was 4.85 per 1,000 central line days.

Conclusion

Using QI principles, compliance with CLABSI maintenance care bundles improved, and the CLABSI rate per 1,000 central line days was reduced to below five.